Education and Training report

Submitted by Dr. Robert Woollard

2017-18 Highlights

The Partnership Pentagram (aka 5 Partner Pentagram) brings together stakeholders in a collaboration to work towards health systems improvement

As a coordination centre, the RCCbc is engaged on a number of levels and scales with novel and with ongoing projects. This ranges from design, initiation, and deployment through to evaluation and feedback loops—reflections of both the individual arts and the impact of the whole. Reflecting a generalist approach, the RCCbc attempts to “…keep the whole in mind while attending to the individual parts, the system in mind when fixing individual problems and the end in mind when commencing the journey.” This has particular relevance to the numerous activities under the rubric of education and research—or, more inclusively scholarship. Many of these activities are reported elsewhere (UBC Chair, evaluation, etc).

The cross linkage of such examples as the Research Awards and the Research Network provides an excellent example of scholarship capacity building at inclusive levels from the individual practices, through communities to regions and to the province as a whole. Similarly, the awards programs for Leadership and Global Health create opportunities that not only contribute to skill development, but increase resilience, retention and community capacity for appropriate health services. This is not surprising given the strong international flavor of BC’s rural health professions.  These programs, as well as the formal annual service recognition awards are moving more and more into interprofessional training, skill development and quality improvement since the rural scale reflects fully the need for teams in all of our activities—a need more reflected in aspiration and rhetoric than action in much of the formal educational systems. Collaboration with BCMQI, and specifically the Multi-professional Teams QI work with the Rural Surgical and Obstetrics Network (RSON) initiative embraces understanding of how effective teams work in BC and how RSON can custom build the required multilevel teams required for its success. The data coming out of the NITAOP and other evaluation initiatives provides useful knowledge about rural practice in BC. Beyond that, the RCCbc seizes the opportunity to develop institutional skills to better understand the complex adaptive system that is rural practice; and then, through the Rural Site Visits, Evaluation, research and other initiatives of RCCbc is using the engagement approach using the Partnership Pentagram to build true feedback loops—the essence of supporting positive systems change.

Submitted by Dr. Brenda Huff

2017-18 Highlights

Leading our 2018’s BC Rural Health Conference (RHC) has been both an exciting and rewarding experience. It’s been a rewarding experience in part because both myself and RCCbc/UBC CPD team members are passionate about medical education especially when it brings rural doctors and allied health professionals together to share knowledge, experiences as well as new innovations in health care. Holding the conference in a new location in 2018 has given us the opportunity to reach out to new speakers, community medical leaders and local First Nations peoples.

In Fall of 2017, I updated and maintained both a local and province-wide RCCbc speaker database. I sought out and connected with new rural physician and allied health professionals in search of new speakers and conference topics. We decided to disrupt the ‘usual’ conference prototypes and to offer a ‘soft theme’ (2018 was ‘provider wellness’) and some accredited courses that may appeal to younger physicians. By reviewing previous conference evaluations and brainstorming, we identified key CPD topics for workshops, small group sessions and plenaries.

I chaired both administrative and planning committee meetings, reached out personally to many of our 2018 speakers and worked with UBC CPD and RCCbc staff members to complete the agenda by the beginning of December 2017. In December 2017 I travelled to Vancouver to complete the conference content scheduling with our amazing Core team. Over the last three months, we have improvised, innovated and finalized many conference details.

View photos from the 2018 BC Rural Health Conference

2018 BC Rural Health Conference

Submitted by Dr. Bob Bluman

2017-18 Highlights

Clinical Coaching for Excellence – This innovative program started with Family Practice Anesthetist (FPA) clinical coaching in five (5) communities. The success of the initial pilot has resulted in the program being extended 11 communities, one of which is self-funded. UBC CPD developed a new orientation to bring together FPAs and coaches at the beginning of the program. Coaches engaged in the program have all completed their training and are all specialists from larger centres (with the exception of one FPA from Cranbrook) who fly into smaller communities to provide onsite coaching. The relationship is continued via telehealth. Research and evaluation for this program has been very positive.

Clinical coaching was launched in the communities involved in the Rural Surgical and Obstetrics Network (RSON) – main success has taken place in Revelstoke, which successfully completed coach training for nursing, obstetrics, surgery, anesthesia. An article detailing this work was accepted for publication.

Emergency Medicine Peer Coaching stream – This initiative – supported by Dr. Danette Dawkin – was launched in early 2018. New to rural providers who are also new to emergency medicine are matched with peers in the community who have significant EM experience. The experienced physicians are given an orientation and trained to provide coaching. Training took place in the summer of 2017 in Fort St. John. Several coaches have completed the program, with one or two still completing their training. The initiative has been well received.

This initiative will be leveraged to support Practice Ready Assessment BC (PRA-BC) program candidates who successfully complete their orientation/assessment and are heading into rural communities, as it was found that this group lacked confidence in their ability to deliver EM care. UBC CPD staff connect with each PRA-BC candidate and link to their destination community to identify needs/gaps and to train/coach the candidate accordingly. Dr. Bruce Hobson is the physician lead for this initiative and will be tasked with developing learning plans to promote success.   Coach training for this stream began in April 2018.

New to Rural Practice Mentoring Program – Dr. James Card is now co-leading this successful program with Dr. Bob Bluman, which started its sixth cohort in April 2018. The program continues to expand and evolve to meet the needs of the wide variety of people entering rural medical practice in BC. Many PRA-BC candidates are participating in the program, along with international medical graduates (IMGs) and Canadian medical graduates. There are now three cohorts offered during a year to allow people to step into the program when it best suits their schedules.

The HOUSE course involves pre-reading, which frees up the learner to mazimize scanning time and interaction with course instructors

HOUSE Program – UBC CPD won the prestigious College of Family Physicians of Canada’s CPD Program of the Year Award for its Hands On Ultrasound Education (HOUSE) Program. The program continues to be well received and well utilized by BC rural physicians.

HOUSE-OB has added new units to this course to train rural family physicians and midwives on the use of ultrasound to answer key questions about the first trimester of a pregnancy.

To learn more about what UBC Rural CPD has accomplished during 2017-18, download the full annual report now.

Submitted by Dr. Dan Horvat

2017-18 Highlights

Dr. Horvat is contributing to the development of a ‘bottom up meets top-down’ strategy to support improving rural health services and to inform the BCMQI. Activities have included:

Rural Innovators – following up from a workshop held during May 2016, rural GPs and specialists were contacted to participate in an advisory group. The aim of this group is to assist with identifying what is and/or is not working with respect to rural health services, and what can be done to make a constructive difference. Discussions are occurring regarding what the participants would like to get out of such a group and an initial meeting.

Rural Innovators Workshop – preparation of a summary of the proceedings from February 22, 2017 Rural Innovators Workshop. The workshop brought together leaders representing rural health service providers, Divisions of Family Practice, Medical Staff Associations, Health Authorities, and the UBC Faculty of Medicine with the aim of improving alignment and synergies. Activities of participants were discussed as were concepts such as networks, pentagram partnership, complex adaptive systems, learning organizations and collective impact. The outcomes were presented and discussed with the Core group, and informed the development of a document, approved by RCCbc Core, outlining how these concepts can assist RCCbc in aligning with current activities of other organizations.

Practice Improvement Hub –  assisting with leading the development of an ongoing forum that brings together RCCbc, the UBC Faculty of Medicine, the Practice Support Program, the BC College of Family Physicians, the College of Physicians and Surgeons of BC, and the Health Data Coalition to consider how organizations can work together more effectively to supported improved clinical practice in rural BC. The second meeting of the forum will occur on June 15, 2018.

March 19, 2018 Network Leadership dinner – gathering together leaders from the BC Emergency Medicine Network, the Family Practice Oncology Network, Rural Surgical and Obstetrics Network (RSON), and provincial palliative care services to consider what processes and infrastructure, if co-developed, could support the development of a wide range of clinical networks.

Dr. Horvat is also involved in ongoing discussions with BCMQI leadership to liaise regarding the concerns of rural physicians, and to assist in developing a health system and quality improvement strategy that serves rural BC but is also beneficial for the province.